Provider Demographics
NPI:1841225786
Name:LAROCHE, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LAROCHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21541 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1736
Mailing Address - Country:US
Mailing Address - Phone:718-217-0424
Mailing Address - Fax:718-217-0459
Practice Address - Street 1:21541 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1736
Practice Address - Country:US
Practice Address - Phone:718-217-0424
Practice Address - Fax:718-217-0459
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202107207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01749444Medicaid
NYG34486Medicare UPIN
NY01749444Medicaid
NY02534Medicare PIN